Organization
LITTLE LANTERN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BIJU LUKOSE MD (CEO)
(979) 358-0435
Entity
Organization
Contact information
Practice address
2705 DAMSEL BELLA BLVD, LEWISVILLE, TX 75056-6169
(979) 358-0435
Mailing address
2705 DAMSEL BELLA BLVD, LEWISVILLE, TX 75056-6169
(979) 358-0435
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
M7387
TX
208D00000X
General Practice Physician
Primary
M7387
TX
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
06/03/2015
Last updated
03/14/2017
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